AT CHILDREN'S HOSPITAL in Washington, a clutch of third-graders, clad in miniature scrub gowns, mills noisily about the atrium lobby, trying out stethoscopes and pumping up blood pressure cuffs.
Small heads bob among X-ray machines and exhibits of emergency room equipment. The orthopedics department, demonstrating casting techniques, has gathered a little crowd, where doctors are fitting the children's fingers with slip-on casts, then letting the kids paint these "hard bandages" to make whimsical finger puppets.
Although the atmosphere is playful, there's a serious purpose behind all this energy. It's a tour for local school children, aim at making them feel more comfortable with hospitals, in case they ever wind up in one.
Susan Salisbury-Richards, who coordinates these activities, says, "Getting well children in allows them to learn when they are not stressed by illness."
Another staff member, Betsy McGuire, adds, "When you have knowledge and information, you have a sense of control. Then children feel more like participants than victims."
A few decades ago, a boisterous group of third-graders would not have been allowed to finger the medical equipment in a big-city hospital. But within a generation, vaccines and advance treatments have wiped out such contagious diseases as polio and whooping cough, and with them has gone the absolute need for a rigid and isolating environment.
Kids still speed plenty of time in the hospital -- ironically, improved treatments for chronic illnesses may keep some hospitalized longer than in the old days -- but their stays are considerably more comfortable.
With the support of an organization called the Association for the Care of Children's Health, young patients these days have the advantage of art and music therapy, picnics, games even visits by clowns and live animals.
Parents, once restricted to fixed visiting hours, often can be with their children anytime. This new atmosphere is due in large part to professionals such as Salisbury-Richards who work in an area called Child Life services.
About 80 percent of the hospitals in the United States offer Child Life programs. Those at large long-established hospitals such as Massachusetts General in Boston, Bellevue in New York City and Johns Hopkins in Baltimore are particularly ambitious.
Hopkins, with 15 Child Life specialists, has one of the oldest programs in the country.
Most metropolitan hospitals, however, have programs about the size of the one at Lutheran General in Park Ridge, a suburb of Chicago.
There, Linda Bieschke, a 12-year Child Life veteran, is a staff of one, but she has 35 volunteers to help run activities for a 35-bed pediatrics ward.
In the music therapy program, children are encouraged to express their emotions, say fear or confusion, with instruments, and to carry on musical "conversations" with each other. If the idea fills the playroom with clattering cacophony, it also adds some happy disorder to what can otherwise be a formidable world.
Bieschke helps the children make cuttings from the playroom ivy plants and pot the plants in their rooms, using tongue depressors to support the stalks and needleless syringes to water them.
Allowing children to play with safe-to-handle medical supplies is a technique to make the equipment seem less threatening, says Bieschke: "There's always a purpose behind what we do."
Wednesday is "picnic day," when young patients who are will enough meet in the playroom and make their own sandwiches.
"We want kids to have choices in an environment with so few choices," Bieschke says. Even a small decision -- beef or ham, pickle relish or mayonnaise -- can make a difference, she says. Twice a month, veterinarian-screened puppies come to visit.
At Fairfax Hospital in northern Virginia, Child Life specialist Calli Sergentanis uses dolls that are nearly 3 feet high to help children entering the 60-bed pediatrics ward learn about hospital procedures.
Each doll's chest opens to reveal a layer of appliqued pink muscles, which lifts up to show, among other things, a yellow corduroy gallbladder and a detachable appendix -- allowing hospital staff to "remove" an organ and prepare youngsters for upcoming surgery.
Children need all kinds of reassurance about hospital stays. Doris Klein, a Child Life specialist at the University of Colorado Health Sciences Center in Denver, points out that even simple misunderstandings can have a tremendous negative impact.
"You have to make sure that information hasn't gotten twisted," she said. Small children, when told about the dye they will receive for an X-ray, for example, sometimes hear the word as "die." So it's a good idea to ask the child to repeat what's been said.
At Fairfax Hospital and other institutions that treat young cancer patients, peer support groups help youngsters better understand what to expect and also give them a place to talk out their fears.